tbuckley/cabot-search huggingface dataset:
Dermocosmetics in management of cancer-related skin toxicities: International expert consensus.
Authors: Brigitte Dreno, Kiarash Khosrotehrani, Giselle De Barros Silva, Julie Ryan-Wolf, Delphine Kerob, Mark G. Trombetta, Etienne Atenguena Okobalemba, Pascale Dielenseger, Meng Pan, Mario E. Lacouture
Journal: Journal of Clinical Oncology (2023)

e24115 Background: Skin toxicities – one of the most frequent adverse events associated with cancer therapies – can occur with all types of cancer therapeutic interventions. New side effects emerge as new oncology drugs are approved (eg, targeted therapies, immunotherapies), which are associated with a negative impact on quality of life, oncologic treatment dose reductions and/or treatment discontinuation. From a pathophysiologic point of view, skin toxicities during cancer treatment result mostly from alterations in skin barrier function, inflammation, altered immune responses, and phototoxicity. Minimizing alterations in skin barrier function and photoprotection facilitate prevention and management of adverse events to optimize treatment outcomes. Methods: In partnership with the Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC), a group of international experts (dermatologists, oncologist, radiation oncologist, oncology nurse) involved in management of cancer patients performed a literature review and a consensus meeting to discuss the role of dermocosmetics to prevent or manage skin adverse events induced by oncology treatments. Dermocosmetics, or cosmeceuticals, include a range of products that can have both therapeutic and cosmetic value. These products help support and maintain the epidermal skin barrier and cutaneous microbiome. Some have been formulated for skin that is fragile, pathological, and sensitive. Results: General recommendations: 1) skin care should be implemented at initiation of therapy for drugs associated with skin toxicities, since prevention is a crucial aspect of management. 2) Skin hydration relieves symptoms and reduces exacerbations of xerosis. 3) Cleansers should have a pH close to 5, while basic and neutral pH cleansers should be avoided. 4) Urea, particularly in the case of some oncology treatments leading to hand foot syndrome, is important due to its exfoliating and hydrating actions. Urea should be avoided with irritated skin. The group also developed recommendations for the management of specific skin toxicities. Conclusions: Emerging evidence is providing support for the beneficial impact of dermocosmetics in management of treatment-related skin toxicities.
Patient navigation for lung cancer screening in an urban safety-net system: A pragmatic randomized clinical trial.
Authors: Sheena Bhalla, Vijaya Subbu Natchimuthu, Jessica L. Lee, Urooj Wahid, Hong Zhu, Noel O. Santini, Travis Browning, Heidi A Hamann, David H. Johnson, Hsienchang Chiu, Simon Craddock Lee, David E Gerber
Journal: Journal of Clinical Oncology (2023)

10577 Background: Although low-dose computed tomography (LDCT)-based lung cancer screening (LCS) can decrease lung cancer mortality in high-risk individuals, it may be a complex and time-intensive process that poses challenges to patients, particularly those from minority, under- and uninsured populations. We conducted a pragmatic randomized controlled trial of telephone-based navigation for LCS within an integrated, urban safety-net healthcare system (Parkland Health, Dallas, Texas). Methods: Patients eligible for LCS based on United States Preventive Services Task Force 2013 Guidelines were randomized (1:1) to usual care with or without phone-based navigation. Following a structured protocol, navigators made systemic contact with patients to provide appointment reminders, share information and resources, assess barriers to LCS, and address smoking cessation. The primary endpoint was completion of the first three consecutive steps (eg, 3 annual LDCTs or LDCT, other imaging, biopsy) in a patient’s LCS process. We also explored differences in completion of LCS steps in navigation and usual care groups according to patient characteristics using chi-square test. Results: Patients (n=447) were randomized to phone-based navigation (n=225) or usual care (n=222) between February 2017 and February 2019. Mean patient age was 62 years, 46% were female, and 69% were racial-ethnic minorities. There was no significant difference in completion of the first three steps of the LCS algorithm (12 vs. 9%; P=0.3) between arms. Completion of LCS steps was not impacted by navigation among different subgroups, including age (&lt;65 vs. ≥65 years), gender (male vs. female), race/ethnicity (non-hispanic white vs. racial minorities), and comorbidity status (Charlson Comorbidity Index &lt;5 vs. ≥5). A key reason for step non-completion was lack of order placement. In the navigation arm, 368 of expected 675 steps (55%) were ordered, and in the usual care arm, 344 of expected 666 steps (52%) were ordered. Despite low three-step completion rates overall, the majority (&gt;75%) of LCS algorithm steps were completed when ordered by their clinical team(Table). In exploratory univariable analysis, completion rates for ordered steps were 86% for navigation and 79% for usual care ( P=0.03). Conclusions: In this study, lack of order placement was a key reason for incomplete LCS steps. When orders were placed, navigated patients had higher rates of completion. Clinical team education and enhanced EHR processes to simplify order placement, coupled with patient navigation, may increase LCS uptake and completion in safety-net healthcare systems. Clinical trial information: NCT02758054 . [Table: see text]
Disparities in intensity of care at the end-of-life for patients with gastrointestinal cancer.
Authors: Gladys M. Rodriguez, Kris Kapphahn, Manali I. Patel
Journal: Journal of Clinical Oncology (2023)

6558 Background: Racial/ethnic minority patients experience disparities along the cancer continuum. Studies show that racial/ethnic minorities with cancer have higher rates of intensity of care at the end-of-life (EOL) compared to non-Hispanic Whites (NHW). Less is known whether disparities in intensity of care at EOL exist among racial/ethnic minority patients with a gastrointestinal (GI) cancer. Methods: Using the California Cancer Registry linked to hospital discharge data, we conducted a retrospective study of patients ≥18yrs with upper GI, pancreatic, or colorectal cancer who died from 2005-2018. We evaluated if race/ethnicity was associated with EOL intensity of care defined as hospital/ED visit or death, ICU, intubation, CPR &amp; dialysis within 14-days of death. We used logistic regressions to calculate odds ratios adjusting for age, socioeconomic status (SES), insurance, geography, stage, comorbidities, and NCI-designated centers. Results: 189,837 patients with GI cancer died: 41,389 (21.8%) with upper GI, 46,554 (24.5%) with pancreatic &amp; 101,894 (53.7%) with colorectal cancer. 118,995 (62.7%) were NHW, 14,146 (7.5%) Black, 33,802 (17.8%) Hispanic &amp; 22,894 (12.1%) Asian/Pacific Islander (API). Median age was 74.6 yrs, 54.1% male, 85.9% lived in urban areas, 48.9% had Medicare, 16.1% had low SES &amp; 35.7% had Stage 4. Black, Hispanic, and API patients compared to NHW had higher odds of intensity of care at EOL (Table). Conclusions: This study shows disparities in intensity of care at the EOL among racial/ethnic minorities with GI cancers. Solutions are urgently needed to reduce such disparities in care. [Table: see text]
Acute myeloid leukemia (AML) outcomes in the era of novel therapies: A 9-year single-institution experience.
Authors: Kriti Gera, Daniela Martir, Zhongyue Zhang, Carolyn Brooke Adams, Ashley Richards, Jack Hsu, John W. Hiemenz, Randy Brown, Erin Dean, Nosha Farhadfar, John R. Wingard, Zeina Al-Mansour
Journal: Journal of Clinical Oncology (2023)

e19053 Background: Recent advances and approval of multiple targeted and non-targeted agents have significantly transformed care for Acute Myeloid Leukemia (AML) over the past 5 years, particularly for older/unfit patients. While this has provided clinicians with several treatment options in both upfront and relapsed/refractory setting, it has also increased the complexity of clinical decision making. Although several trials have shown immense promise of these therapies, the real-world outcomes have not been reported. The primary aim of this study is to compare survival outcomes in newly diagnosed and relapsed AML before and after the introduction of the novel AML treatments that were granted FDA approval over the past 5 years. Methods: We performed a retrospective single-center analysis on adult patients (≥ 18 years) with newly diagnosed and relapsed AML treated at University of Florida Cancer Hospital between January 2012 and December 2020. Patients were stratified according to the time of diagnosis and Overall survival (OS) was estimated using Kaplan Meier method. Survival between groups was compared using log-rank test. Results: A total of 1617 patients were included in this analysis. Median age was 61 years (range 18-83) and 54.4% of patients were men. 71.4% patients were of white race. Median OS was 71.5 months with 1-year OS of 67.4%. Women had significantly better survival than men (1-year OS: 72% vs 63.6%, p=0.0043). 1-year OS for patients diagnosed in 2012-14, 2015-17 and 2018-20 was 73.5%, 67.6% and 58.1% respectively (p &lt; 0.0001). There were no significant differences in survival based on race. 21.4% (n=347) patients had relapse of AML. Median OS for AML relapse was 9.8 months with 1-year survival of 45.1%. There were no significant differences in survival of patients based on race, sex and year of diagnosis. Conclusions: Our study reports decline in 1-year survival of patients with AML in the modern era despite introduction of several novel therapies in recent years. Additionally, relapsed AML continues to have dismal outcomes despite the availability of multiple novel agents for R/R AML. These results are surprising given the reported good efficacy of these agents in clinical trials. Possible explanations include under-representation of real-life patients in clinical trials, poor tolerability of these therapies by the average patient, and/or barriers to access to these novel therapies in healthcare due to prohibitive high cost, inadequate insurance coverage, or limited availability. Larger-scale real-life population-based studies are needed to further investigate the validity of these findings. [Table: see text]
Immune checkpoint inhibitors use and the incidence of hepatitis B virus reactivation or immune-related hepatitis in non-small cell lung cancer patients with chronic hepatitis B.
Authors: Joohyun Hong, Jiyun Lee, Sehhoon Park, Hyun Ae Jung, Jong-Mu Sun, Se-Hoon Lee, Jin Seok Ahn, Dong Hyun Sinn, Myung-Ju Ahn
Journal: Journal of Clinical Oncology (2023)

9086 Background: The safety and efficacy of immune-checkpoint inhibitors (ICIs) has not been thoroughly investigated in non-small cell lung cancer (NSCLC) patients with chronic hepatitis B (CHB) or occult hepatitis B infection (OBI). We analyzed incidence of hepatitis B virus (HBV) reactivation, immune-related hepatitis and jaundice in NSCLC patients treated with ICIs according to HBV DNA and hepatitis B serologic markers in real-world setting. Methods: A total of 1,277, consecutive NSCLC patients treated with ICIs from January 2015 to December 2020 at the Samsung Medical Center, Seoul, Korea were analyzed. Among them, 52 patients were hepatitis B surface antigen (+) (Group A, CHB), 759 patients were HBsAg (-)/anti-HBc IgG (+) (Group B, OBI), and 466 patients were HBsAg (-)/anti-HBc IgG (-) (Group C). Among 52 patients with CHB, 38 patients (73.1%) were receiving antiviral therapy. Primary endpoint was HBV reactivation, immune-related hepatitis and jaundice. Secondary endpoints include other immune-related adverse events, objective response rate, progression free survival (PFS) and overall survival (OS). Results: HBV reactivation was observed in two patients (0.2%) which was exclusively observed in Group A (CHB). Among CHB patients who were not receiving antiviral therapy, HBV reactivation was observed for 14.3% (2/14 patients). Incidence of immune-related hepatitis were 21.2%, 30.3% and 30.5% for Group A, Group B and Group C (p &gt; 0.05), respectively, and incidence of immune-related of jaundice was 3.8%, 4.0% and 2.8% for Group A, Group B and Group C (p &gt; 0.05), respectively. Incidence of ≥ grade 3 other immune-related adverse events, objective response rate, PFS, and OS were comparable among three group (p &gt; 0.05 for all comparison). Conclusions: In this large, real-world cohort study, safety and efficacy of ICIs were comparable in patients with CHB or OBI, suggesting similar outcomes can be expected with ICIs in patients with CHB or OBI. HBV reactivation was observed in patients with CHB without antiviral therapy indicating antiviral prophylaxis might be required for them. For patients with OBI, risk of HBV reactivation was null.
Reality check for precision oncology in squamous cell lung cancer.
Authors: Maham Bakhtyar, Sajjad Akbar Bhatti
Journal: Journal of Clinical Oncology (2023)

e21221 Background: Squamous cell lung cancer (SqCLC) is the second most common type of pulmonary malignancy after lung adenocarcinoma. Therapeutic advances in Precision Oncology have significantly improved outcomes in subsets of patients with lung adenocarcinoma. However, a significantly different mutational landscape has limited the success of Precision Oncology in SqCLC. Still, NCCN guidelines recommend considering molecular testing in SqCLC, preferably with broad-based molecular profiling like next-generation sequencing (NGS), aiming to identify candidates for FDA-approved targeted therapy. We aim to evaluate the percentage of SqCLC potentially eligible for targeted therapy using NGS by analyzing data from The Cancer Genome Atlas (TCGA). Methods: We filtered cases with a SqCLC diagnosis from the TCGA database. These cases were screened for DNA/RNA alterations in the 9 NCCN-guidelines recommended genes, including EGFR/ALK/ROS1/BRAF/MET/RET/HER2/NTRK/KRAS. Each unique alteration in the genes mentioned above was then analyzed in the oncoKB database to predict clinical benefit with level 1 and 2A evidence from FDA-approved targeted therapy. We then calculated the percentage of patients with SqCLC tested with NGS who could assess approved matched targeted therapy. Results: We identified 501 unique cases of SqCLC diagnosis in the TCGA. In the 9 NCCN-recommended actionable genes, 206 alterations were detected. We reviewed the clinical implication and utility of each of these alterations in the OncoKB database, and only 5 alterations were consistent with level 1/2A clinical benefit from a matched targeted therapy. These included 2 cases with L861Q and one each with EGFR L858R, EGFR E746_A750 exon 19 deletion, and G222C missense in the ERBB2 gene. Conclusions: The percentage of squamous cell cases which are potential candidates for FDA-approved targeted therapy was relatively low, 0.1% (5/501). While next-generation sequencing will not affect the standard of care treatment options for most SqCLC patients, clinicians can use this information to counsel patients for enrollment in clinical trials. [Table: see text]
Adverse events with the use of radiotherapy in patients with inflammatory arthritides and cancer: A systematic review and meta-analysis.
Authors: Maria A. Lopez-Olivo, Gaurav Sharma, Sehrish Qureshi, Rachel S. Hicklen, Jean H. Tayar, Maria E. Suarez-Almazor
Journal: Journal of Clinical Oncology (2023)

e24090 Background: Radiotherapy is a cornerstone for multi-modality cancer treatment. However, there have been concerns that in patients with inflammatory arthritides (i.e., rheumatoid arthritis, juvenile idiopathic arthritis ankylosing spondylitis, Still’s disease) radiotherapy could result in deleterious outcomes, and radiation oncologists may be hesitant to administer radiation therapy to these patients. Methods: We conducted a systematic review to determine the risk of developing adverse events (AEs) from radiotherapy in patients with cancer and inflammatory arthritides. We searched in 4 electronic databases from inception through October 2022. Study selection, data collection and risk of bias assessment were independently performed by two investigators. We performed random-effects meta-analysis to determine the incidence of acute (≤ 90 days) and late ( &gt; 90 days) AEs and evaluated the risk of developing AEs in these patients compared with cancer patients without inflammatory arthritides. Results: Out of 9,723 records retrieved from our searches, we included 7 cohort studies (5 included a control group) and 14 case reports (describing 22 patients). The age of the included patients ranged from 16-72 years. The median follow-up ranged from 1.5 to 12.5 years. Median radiation doses ranged from less than 40 Grays (exact doses not provided) to more than 60 Grays. The pooled incidence of acute AEs for patients with inflammatory arthritides when considering controlled and uncontrolled studies was 32% (95%CI 14%, 53%). When compared with controls (cancer patients receiving radiotherapy without inflammatory arthritides) no statistical difference was observed (Relative risk [RR] using only controlled studies 1.3; 95%CI 0.67, 2.5). For late AEs, the pooled incidence for patients with inflammatory arthritides when considering controlled and uncontrolled studies was 20% (95%CI 8%, 34%). However, the AEs in patients with inflammatory arthritides was significantly higher than that of controls (RR using only controlled studies 2.3; 95%CI 1.3, 4.3). The most common acute AEs reported were radiation dermatitis, gastrointestinal or genitourinary toxicity, and flares of the autoimmune disease. The most common late AEs reported were fibrosis, lymphedema, and pneumonitis. Out of the case reports, 5 patients reported late AEs and the remaining patients did not report AEs. Conclusions: While there were no differences in the frequency of acute AEs, patients with inflammatory arthritides had a statistically significant increased rate of late AEs compared with people without arthritides. Our results can assist in providing evidence-based information to patients with inflammatory arthritides considering radiotherapy.
Artificial intelligence algorithm developed to predict immune checkpoint inhibitors efficacy in non–small-cell lung cancer.
Authors: Mehrdad Rakaee, Masoud Tafavvoghi, Elio Adib, Biagio Ricciuti, Joao Victor Machado Alessi, Alessio Cortellini, Claudia A.M. Fulgenzi, Kajsa Møllersen, Lars Ailo Bongo, Sayed MS Hashemi, Ilias Houda, Lill-Tove Rasmussen Busund, Tom Donnem, Idris Bahce, David J. James Pinato, Lynette M. Sholl, Mark M. Awad, David J. Kwiatkowski
Journal: Journal of Clinical Oncology (2023)

9132 Background: Many non-small cell lung cancer (NSCLC) patients with high PD-L1 IHC expression and/or high TMB level do not respond to immune-check point inhibitors (ICIs). Discovery of novel predictive biomarkers for ICI response in NSCLC continues to be a critical unmet medical need, given the expense, potential toxicity, and therapeutic delay due to ICI treatment without benefit. Methods: We developed a supervised deep learning algorithm (Deep-IO) to predict therapeutic response to ICIs in NSCLC patients from standard histology whole slide hematoxylin and eosin (H&amp;E) images, which was trained based on ICI objective response rate. We utilized a convolutional neural network (CNN) implemented in Pytorch. The efficiency of the Deep-IO was evaluated through classification performance metrics and the area under the receiver operating characteristic curve (AUROC). The algorithm was trained and tested on 85218 tiles (size: 512x512 pixels) in 446 advanced stage NSCLC patients from the Dana Farber Cancer Institute (DFCI), all treated with ICI monotherapy. Results: The objective response rate, comprising complete and partial response, was 26% (n = 114) in the overall cohort. The DFCI patient cohort was randomly split into a training set (N=379, 85%) and a test set (N=67, 15%). The classifier’s predicted class (responder vs non-responder) probabilities at the tiles level were averaged for each patient. Quantitative evaluation of whole section test dataset shows that the developed model achieves the accuracy of 0.72, weighted average (WAVG) precision of 0.77, WAVG recall of 0.72 and WAVG F-score of 0.74 on classifying ICI non-responders from responders. Comparing with PD-L1 expression (TPS%) and TMB (mu/Mb), Deep-IO had superior predictive power for ICI response (AUROC=0.75) in the test set. The combined Deep-IO+PD-L1 scores resulted in a significantly greater AUROC value of 0.82 compared to single tests and a 32% improvement in specificity (0.88 vs. 0.56) compared to PD-L1 evaluation alone (Table). Conclusions: This proof-of-concept study shows that an artificial intelligence–powered H&amp;E image classifier can predict ICI effectiveness in NSCLC. Deep-IO outperformed both established predictive biomarkers. We will assess Deep-IO in additional external NSCLC data sets for validation and confirmation. [Table: see text]
Evaluating disparities in pancreatic cancer outcomes in African Americans.
Authors: Shiva Shrotriya, Bipin Ghimire, Ujjwal Karki, Tara Rangarajan, Can Wang, Kadhim Al-Banaa, Hycienth Ahaneku, Shyam K Poudel, Paul Hanona, Daniel Ezekwudo, Ishmael A. Jaiyesimi, Dana Zakalik
Journal: Journal of Clinical Oncology (2023)

e18657 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes observed in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We sought to evaluate the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and progression free survival (PFS) based on race were analyzed. Results: The cohort (N = 983) consisted of 154 (16%) African Americans (AA) and 803 (82%) Non-Hispanic Whites (NHW). The median age at diagnosis was 65 years (60, 70) among AA and 71 years (64, 78) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI &gt; 30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). The treatment modality consisted of chemotherapy (57% in AA vs. 61% in NHW), surgery (26% in AA vs. 27% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 24 (16, 41) months for AA and 34 (20, 56) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in progression free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. Although there was a shorter time to treatment initiation among AA, there was no significant difference in progression free survival compared to NHW when adjusted for other variables. Future studies incorporating novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.